There is no cure for endometriosis and it can be difficult to treat. Treatment aims to ease symptoms so the condition doesn't interfere with your daily life.
Treatment will be given to control or improve symptoms and improve fertility.
Deciding which treatment
Your gynaecologist will discuss the treatment options with you and outline the risks and benefits of each.
When deciding which treatment is right for you, you should consider:
- whether your main symptom is pain or difficulty getting pregnant
- whether you want to become pregnant, as some treatments may stop you from getting pregnant
- how you feel about surgery
- whether you've tried any of the treatments before
You may choose not to have treatment if your symptoms are mild, you have no fertility problems or if you're nearing menopause, when symptoms may get better without treatment.
One course of action is to keep an eye on symptoms and decide to have treatment if they get worse.
Support from Endometriosis UK can be very useful if you're learning how to manage the condition.
Paracetamol and Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen, can be used to treat the pain associated with endometriosis.
NSAIDs can cause side effects, such as nausea, vomiting and diarrhoea.
Codeine is a stronger painkiller that's sometimes combined with paracetamol or used alone if other painkillers aren't suitable. However, constipation is a common side effect, which may aggravate the symptoms of endometriosis.
For more information, read the Endometriosis UK factsheet on pain relief for endometriosis
The aim of hormone treatment is to manage the oestrogen in your body.
This is because the hormone oestrogen controls the menstrual cycle and also encourages endometriosis tissue to grow and shed. Without exposure to oestrogen, symptoms can be reduced.
Hormone treatment has no effect on adhesions – scar tissue that can cause organs to fuse together – that have already formed, and it can't improve fertility.
Some of the main hormone-based treatments include:
Evidence suggests these hormone treatments are equally effective at treating endometriosis, but they have different side effects.
Although most hormone treatments reduce your chance of pregnancy while using them, only the contraceptive pill or patch and LNG-IUS are licensed to be used as contraceptives.
Progestogens and antiprogestogens are used less commonly, for people who can't take oestrogen.
The combined oral contraceptive pill or patch
The combined contraceptive pill and contraceptive patch contain the hormones oestrogen and progestogen.
They can be used long-term and stop eggs from being released (ovulation) to make periods lighter and less painful.
These contraceptives can have side effects, but there are several different types available.
Learn more about the combined contraceptive pill or patch
Levonorgestrel-releasing intrauterine system (LNG-IUS) – hormonal coil
The Mirena levonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped contraceptive device that fits into the womb, often referred to as a coil.
It releases a type of progestogen hormone called levonorgestrel and greatly reduces or even stops periods.
The device is put into the womb by a doctor or nurse. Once in place, it can remain effective for up to 5 years.
Possible side effects of using LNG-IUS include irregular bleeding that may last more than 6 months, breast tenderness and acne.
Learn more about the IUS
Gonadotrophin-releasing hormone (GnRH) analogues
GnRH analogues are synthetic hormones that bring on temporary menopause by reducing the production of oestrogen. They're usually taken as a nasal spray or injection.
Menopause-like side effects of GnRH analogues include hot flushes, vaginal dryness and low libido (sex drive).
Sometimes low doses of hormone replacement therapy (HRT) is recommended in addition to GnRH analogues to prevent these side effects.
They're only usually prescribed on a short-term basis (normally 6 months at a time) and your symptoms may return after treatment is stopped.
GnRH analogues aren't licensed as a form of contraception, so you should still use contraception while taking them.
Progestogens, such as norethisterone, are synthetic hormones that behave like the natural hormone progesterone.
However, they have side effects such as:
- mood changes
- irregular bleeding
- weight gain
Progestogens are usually taken daily in tablet form from days 5 to 26 of your menstrual cycle, counting the first day of your period as day one.
Most progestogen tablets aren't an effective form of contraception, so you'll still need to use contraception while taking them if you don't want to get pregnant.
Also known as testosterone derivatives, antiprogestogens are synthetic hormones. They bring on a temporary artificial menopause by decreasing the production of oestrogen.
Side effects of antiprogestogens can include:
- weight gain
- mood changes
- the development of masculine features, such as hair growth and a deepening voice
These side effects are often severe, and alternative medications are more effective. This means antiprogestogens are usually only prescribed as a last resort if other medications haven't worked.
Surgery can be used to remove or destroy areas of endometriosis tissue, which can help improve symptoms and fertility. The kind of surgery you have will depend on where the tissue is.
The types of surgery are:
- laparoscopy – the most commonly used and least invasive technique
Any surgical procedure carries risks. It's important to discuss these with your surgeon before undergoing treatment.
Laparoscopy, also known as keyhole surgery, is a common procedure used to remove endometriosis. Small cuts (incisions) are made in your tummy to insert instruments to see and remove the tissue.
During a laparoscopy, fine instruments are used to apply heat, a laser, an electric current (diathermy) or a beam of special helium gas to the patches of tissue to destroy or remove them.
The procedure is carried out under general anaesthetic, so you'll be asleep and won't feel any pain as it's carried out.
Ovarian cysts, or endometriomas, which are formed as a result of endometriosis, can also be removed using this technique.
While the majority of surgeries for endometriosis are done by laparoscopy, sometimes this is not possible and a laparotomy is undertaken.
During the procedure, the surgeon makes a wide cut along the bikini line and opens up the area to access the affected organs and remove the endometriosis tissue.
Recovery time for this type of surgery is longer than for keyhole surgery.